Pay me now, not later!
Tips for closing the claims-payment cycle
Getting paid promptly, at least by insurance companies, doesn’t happen much anymore in home care. The payment bar has been steadily and sharply rising lately. Some argue the hurdles to getting claims paid are also becoming more and more arbitrary and even just plain silly. Ask William Deary, chief financial officer of Jackson, MI-based Great Lakes Home Health Services.
"One company actually told us, We don’t pay anyone until they call twice.’ I think they offer whatever excuses not to pay. For example, you didn’t submit bills [on green paper]. So the next time, you use green paper and a pen like they told you, but they still don’t pay because you sent the bill on even days and they only pay bills submitted on odd days," he laments.
That’s the bad news. The good news is that as arbitrary and tardy as third party payments are, payments from patients are still pretty much coming in on time. "The private pay is wonderful. Ninety-four percent of our problems are with insurers," says Ethel Baldwin, RN, MPA, CNAA, director of Okemos, MI-based Sparrow Home Care Network.
Treading the payment path
Some tips to speed payments from insurers and keep clients on the prompt payment path include:
• Hire the right billing staff.
Having the right billing staff is critical to reducing the payment cycle, according to Gina Dodson, administrator of Vanderbilt Home Care Services in Nashville, TN. "You need someone with attention to detail, who can build rapport with payers and follow up aggressively," she advises.
It’s also important that billers not get so caught up with the process that they lose sight of collection issues. For example, if a biller starts receiving remittance advice requesting clinical notes from a payer that normally doesn’t require such documentation, he should be able to recognize the trend, Dodson explains.
• Review accounts weekly.
At Great Lakes, the entire finance staff, along with the company’s respective private duty and Medicare division clinical directors, meet weekly to review every account, according to Deary. Staff provide updates on individual accounts, such as when calls have been or will be made, and the expected date of payment. The appropriate division clinical director determines when Great Lakes should contact patients with overdue accounts. That individual also determines whether a clinical or financial staff member should make the initial contact.
Include other clinical departments such as intake, Dodson recommends. They may help identify front-end problems that might ultimately affect payment.
• Invest in systems.
As frustrating as it is dealing with insurers, ultimately providers will have to be even more flexible in the future. "We can’t box ourselves into a corner. We have to have the systems in place to adapt to payer requirements," Dodson says.
System upgrades can help improve the efficiency of patient billing as well. Sparrow Home Health Network, for instance, can now generate bills directly from schedules, Baldwin reports. Mount Marion, NY-based My Nurse uses the Peachtree accounting system. According to owner Sandy Cerul, RN, BSN, the system accommodates the company’s many different pay and billing rates.
• Require client payment contracts.
My Nurse requires clients to sign a payment contract at the start of a case. "It’s not just an authorization for services. It spells out exactly the days, hours, and estimated weekly bills. It helps resolve problems down the line," Cerul explains.
My Nurse contracts also specify that client security deposits are against the last, rather than first, week of service. "That made the most difference in all our collection efforts. Having the deposit against the last — not the first week — [makes them] immediately have to write another check, [and it] makes a psychological difference. We used to have it against the first week, but so many people would start [service] and they’d get the bill and be shocked; so they’d either cancel or cut back. But if they write out the checks upfront, they see in black and white what it’s going to cost," Cerul explains.
• Encourage in-person payments.
The spouse of a person receiving care may see making payments in person at the provider’s office as a social outing. Encourage them to come in, Cerul advises. My Nurse staff offer family members coffee and take time to talk with them. Such visits may not only speed payment, but also uncover any issues simmering on the case.
Another way to make payment easy is by accepting credit cards. Sparrow Home Health Network recently began doing so at the request of customers, Baldwin reports.
Watch out for family members paying on behalf of patients, Dodson warns. "Even if [the money] is coming out of the patients’ funds, you really have to work with them," she says.
• Act immediately on late accounts.
If a private pay account is more than a week late, Cerul makes a personal visit to the patient’s home. "I don’t pressure them. I do it as a regular supervisory visit, but they usually pay me at the time," she says.
Deary expects Great Lakes Home Health billers to consistently call on accounts. On insurance claims, they stamp a notice about the state of Michigan’s prompt-payment law. The weekly billing meetings provide a forum to determine next steps for delinquent accounts.
• Avoid adversarial relationships.
Tempting though it may be, don’t strike an adversarial position with frontline case managers and billers at insurance companies. They can be your advocate, especially when there is a systemwide problem, Dodson advises. Vanderbilt Home Care experienced such slow payment from Tennessee Medicaid that it finally had to inform officials that it would no longer accept Medicaid patients. By the time that happened, the case managers were allies in helping tap the drums of the Medicaid bureaucracy to a faster beat.
While you shouldn’t be afraid to threaten or actually discontinue services, it’s wise to time that action well, Dodson says. "Don’t play your trump card too early because it may create an adversarial relationship," she says.
• Enlist support from field staff.
Field staff don’t like to get involved in collecting accounts, and it’s not necessary that they do so to still be of help, according to Cerul. They are an excellent source of information that can help forestall problems. A word in the office that a client is mentioning money more often may be an important clue. Have a supervisor go out and meet with family if you receive such news, she advises.
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